Provider Demographics
NPI:1265880843
Name:MIND BODY WELLNESS NETWORK
Entity type:Organization
Organization Name:MIND BODY WELLNESS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-643-8345
Mailing Address - Street 1:8040 161ST AVE NE # 398
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3807
Mailing Address - Country:US
Mailing Address - Phone:206-643-8345
Mailing Address - Fax:
Practice Address - Street 1:15600 REDMOND WAY STE 303
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3862
Practice Address - Country:US
Practice Address - Phone:425-558-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60343948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty